Provider Demographics
NPI:1710181532
Name:HOLLOBAUGH, SUSAN ANN (PA)
Entity Type:Individual
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First Name:SUSAN
Middle Name:ANN
Last Name:HOLLOBAUGH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:9500 MENTOR AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-352-4880
Mailing Address - Fax:440-352-3629
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-352-4880
Practice Address - Fax:440-352-3629
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2021-03-03
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Provider Licenses
StateLicense IDTaxonomies
OH1142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant